摘要：
1例61岁女性患者因右眼睑裂伤缝合术后出现发热,自行口服头孢羟氨苄片0.5g、2次/d.服药后体温恢复正常,但未停药.用药2周后患者躯干四肢出现皮疹伴剧烈瘙痒,并出现发热(体温39°C),遂停药.但症状进行性加重,5 d后出现面部肿胀,于发病第7天入院.入院时白细胞计数25×109/L,嗜酸粒细胞0.29,嗜酸粒细胞计数7.4×109/L,肝肾功能和心肌酶谱正常,心电图正常.给予抗过敏及对症治疗.入院第4天,患者出现头晕及全身乏力,血压96/61 mmHg(1 mmHg=0.133 kPa),心率110次/min,心电图检查示多导联ST段抬高,超声心动图检查示少量心包积液,实验室检查示心肌肌钙蛋白T(cTnT)1.52μg/L、肌酸激酶(CK)236 U/L、CK-MB 63 U/L、N末端脑钠肽前体(NT-proBNP)9708 ng/L,诊断为药物超敏综合征并发急性心肌心包炎.给予大剂量甲泼尼龙(500 mg/d)静脉滴注、人免疫球蛋白(40 g/d)静脉滴注和营养心肌治疗.入院第5天,患者血压80/50 mmHg,CK 498 U/L,CK-MB 98 U/L,cTnT 5.33μg/L,左心室射血分数55％,转入心血管重症监护病房(CCU).但患者病情进展迅速,转入CCU第3天,CK 1252 U/L,CK-MB 231 U/L,cTnT 4.57μg/L,NT-proBNP 17979 ng/L,左心室射血分数10％;第6天左心室射血分数降至5％;第9天死亡.%A 61-year-old female patient took cefadroxil tablets 0. 5 g twice daily herself due to fever after blepharorrhaphy in her right eye. Her temperature returned to normal,but the medication was not discontinued and 2 weeks later,the patient developed skin rash on her limbs with severe itching,and fever (39 °C). Then cefadroxil tablets were stopped but her symptoms were gradually aggravated,and then facial swelling appeared 5 days later. On the seventh day of onset,she was admitted to the hospital,with white blood cell count 25 × 109 / L,percentage of eosinophils 0. 29,eosinophil count 7. 4 × 109 / L,and normal liver and kidney function,myocardial enzymes,and electrocardiogram. Antiallergic and symptomatic treatments were given after the admission. On day 4 of admission,the patient developed dizziness and general fatigue. Her blood pressure was 96 / 61 mmHg and her heart rate was 110 beats per minute. The electrocardiogram showed multilead ST segment elevations and the echocardiography revealed a small amount of pericardial effusion. Laboratory tests showed that the cardiac troponin T (cTnT)was 1. 52 μg/ L,creatine kinase (CK)was 236 U/ L,CK-MB was 63 U/ L,and N-terminal pro-brain natriuretic peptide (NT-proBNP)was 9708 ng/ L. The patient was diagnosed with drug hypersensitivity syndrome complicated with acute myocarditis and pericarditis. Intravenous infusion of high dose methylprednisolone (500 mg/ d), human immunoglobulin (40 g/ d),and myocardial nutrition treatments were given. On day 5 of admission, the patient was transferred to the cardiovascular care unit (CCU),when her blood pressure was 80 / 50 mmHg,CK was 498 U/ L,CK-MB was 98 U/ L,cTnT was 5. 33μg/ L,and left ventricular ejection fraction was 55％ . However,the patient′ myocarditis and pericarditis progressed rapidly. On day 3 in the CCU,the laboratory tests showed CK 1252 U/ L,CK-MB 231 U/ L,cTnT 4. 57 μg/ L,NT-proBNP 17979 ng/ L,and left ventricular ejection fraction 10％,which then decreased to 5％ on day 6. Finally,the patient died on day 9 in the CCU.
